1.

Introduction

2.

3.

4.

   4.1

   4.2

5.

   5.1

   5.2

   5.3

   5.4

   5.5

   5.6

6.

   6.1

   6.2

   6.3

Delete option available to delete individual component of test of a Radiology Result

   6.4

   6.5

   6.6

   6.7

   6.8

   6.9

7.

   7.1

8.

   8.1

9.

   9.1

   9.2

10.

   10.1

   10.2

   10.3

   10.4

   10.5

   10.6

11.

   11.1

   11.2

   11.3

The release note describes the various new features and enhancements carried out in Version 2.0 Build 12 of PrognoCIS™; with the specifications and UI details wherever applicable.

•  PrognoCIS is now Surescript 10.6 Certified for e- Prescription: Refill; New Rx; and EPCS (Electronic Prescription of Controlled Substances).

•  Additional change include Pharmacy search invoked from the Prescription screen displays two new columns namely, Type Name –displaying the Pharmacy type (i.e. Mail Order, Retail, 24 hour, and Fax Order etc) and Service – the type of services provided by the Pharmacy, these services are visible on tooltip. Refer to the following figure 2.1-1

Figure 2.1-1: Two newly added columns on Pharmacy Vendor search

•  Cross street pharmacy information has been provided in the Address field. Refer to the following figure 2.1-2

Figure 2.1-2: Search result displaying Cross street addresses

Search on basis of Geographic locations (City, State, and Zip) displays pharmacies Mail Order pharmacies along with others.

•  PrognoCIS is now Surescript certified to send eRx for Controlled Substances (CS) of Class I, II, III, IV, and V.

•  Some important terms and requirements of EPCS explained:

A.  Identity Proofing (Signing Credentials)

•  Identity proofing is the process by which the identity of a DEA registrant responsible for signing controlled prescriptions is verified by a qualified organization – by either a qualified credential service provider (CSP) or Certification Authority (CA), it is recommended to use the services of IdenTrust for this purpose.

•  Prescribers who get their identity proofed done by CA obtain a digital certificate to sign EPCS

B.  Two factor authentication (Password + IdenTrust eToken)

•  There are two credentials that every prescriber who has been Identity proofed and is eligible to sign prescription; one is a password (known only to the Prescriber) and an eToken (that at least meets FIPS 140-2 Security Level 1).

•  The eToken currently supported is from IdenTrust. The drivers are provided in the CD from IdenTrust and have to be installed on the PC that is used to send EPCS.

Note:

•  These factors must remain protected and in the sole possession of the DEA registrant at all times. Shared passwords and hard tokens may result in penalties and even revocation of the DEA licensure .

•  eToken details:

Table 3.1: eToken details

C.  URLs for eTokens:

-  http://www.identrust.com/prognocis/index.html

D.  Operating System and Browser requirements

•  The computer system that is used for EPCS prescription has to have Windows Operating System (XP or above); with IE browser version 7 onwards.

•  Active-X should be enabled in the browser – required to send EPCS by reading the digital certificate installed in the IE browser from USB token through the ActiveX component.

E.  MSI Setup

MSI setup is provided by PrognoCIS team, it helps PrognoCIS to communicate with eToken hardware .

Workflow

 I. Clinic interested in enabling EPCS for their Providers approach PrognoCIS team for its implementation in their PrognoCIS EMR.

II. Clinic is informed that two different Users from the Clinic have to be registered, one would be an Approving Provider and the other would be an Enabling User - Enabling User need NOT be a provider he or she can be any user who has been given rights to enable EPCS access for Providers. Approving Provider would perform the role of granting the ability to sign prescriptions; the Provider chosen to be an Approver must be a DEA registrant. Prescriber is a provider in the Clinic eligible to prescribe the CS drug. Refer to the following figure 3.1

Figure 3.1: The role of Enabler, Approver, and Prescriber depicted

III. Similarly two separate eTokens to be purchased for each of them and the PC used by them should have a Windows' OS (XP or above) to Provider's who want to do EPCS as well Providers who are going to act as Approvers will need an E-Token. The PCs used by them should have a Windows’ OS (XP or above).

IV. Both the Users need to install eTokens' drivers from the CD given by the Vendor (eToken is currently supported/acquired from IdenTrust, http://www.identrust.com/certificates/buy_aces_individual.html );

V. Successful installation of eToken driver is confirmed when you see the Safe Net Icon on the Windows tray. Refer to the following figure 3.2

Figure 3.2: e-Token client icon as seen on Windows' tray

VI. Clinic Providers then run the MSI setup (provided by PrognoCIS) on their PC.

VII. PrognoCIS admin then enables New Rx and Refill services to the Providers – if not already present.

VIII. The role of APPROVEEPCS is assigned to the Approver Provider and the role of ENABLEEPCS to the Enabler User (APPROVEEPCS and ENABLEEPCS are two newly added roles in the current version)

IX. Providers on their part get their e-Tokens registered ; UID of e-Token is stored in PrognoCIS when a Provider registers.

X. Approver approves the Prescriber's rights to e-prescribe CS drugs.

XI. Prescriber is now all set to e-prescribe CS drugs from PrognoCIS.

Implementation

There three stages in implementing EPCS in PrognoCIS:

I. Configuration of EPCS Setup (done by PrognoCIS Technical Support Group)

II. Registration of Providers with Surescript

Registration of Providers comprises of two Phase wherein in the first phase the PrognoCIS admin is involved whereas in the second phase PrognoCIS providers are involved. Refer to the following figure 3.3

Figure 3.3: Diagram representing the two phases involved in the EPCS registration

Phase I

Providers sign-up for ePrescription and PrognoCIS’ support team enables them

Phase II

Provider's Access Control assigned ( Approver Provider and Prescribing Provider e-Token registration )

•  Perform the following steps to assign Approver rights to the Provider chosen for approving:

1.  GoTo tab: Settings → Configuration →column: → link: User Role

2.  Select the Provider for whom Approver role has to be assigned from Medics Search popup invoked via Search button.

3.  Select APPROVEEPCS option to assign the Approver role to the selected Provider. Refer to the following figure 3.4

Figure 3.4: Approver's role (APPROVEEPCS) assigned to a Provider

4.  Click Save button to save the settings.

Or

     Click reset button to revert changes up to the last saved change.

•  Perform the following steps to assign Enabler rights to the Provider chosen for Enabling:

1.  GoTo tab: Settings → Configuration → column: → link: User Role

2.  Select the Provider for whom Enabler role has to be assigned from Medics Search popup invoked via Search button .

3.  Select ENABLEEPCS option to assign the Enabler role to the selected Provider. Refer to the following figure 3.5

Figure 3.5: Enabler's role (ENABLEEPCS) assigned to a different Provider

4. Click Save button to save the settings.

Or

    Click reset button to revert changes up to the last saved change.

•  Perform the following steps to enable EPCS for Provider in PrognoCIS (Provider's login):

1.  GoTo tab: Settings → Configuration → column: Medics → link: Provider → Providers screen

2.  Click EPCS button to invoke Access Control for EPCS popup Refer to the following figure 3.6

Figure 3.6: Enable button displayed on Access Control for EPCS popup

3.  Click enable button to enable EPCS for the selected Provider.

4.  Click save button to save the settings.

Or

    Click reset button to revert changes up to the last saved change.

•  Perform the following steps to register EPCS eToken in PrognoCIS (Provider's login):

1.  Connect your individual e-Token to your PC's USB drive.

2.  GoTo tab: Settings → Configuration → column: Medics → link: Provider →Providers screen

3.  Click EPCS button to invoke Access Control for EPCS popup; Refer to the following figure 3.7

Figure 3.7: Before a Provider is registered, the EPCS status is displayed as ‘Disabled' and eToken as ‘Unregistered'

4.  Click on Reg eToken button to register your plugged-in eToken. Refer to the following figure 3.8; the status of eToken becomes ‘Registered’

Figure 3.8: Status of Control Substance displayed as ‘Registered'

Following steps are to be performed by Approving Provider to approve a Prescriber to sign ePrescsription of CS drugs (Provider's login):

1.  Connect your individual e-Token to your PC's USB drive.

2.  GoTo tab: Settings →Configuration → column: Medics → link: Provider → Providers screen

3.  Click EPCS button to invoke Access Control for EPCS popup; Refer to the following figure 3.9

Figure 3.9: Two-factor authentication required of the Approver – one is the eToken already connected plus the password that is entered by the logged in approver in the field provided.

4.  Enter your login password in the Enter password for <Provider's Name> field.

5.  Click approve button to grant approve rights for EPCS to the selected Provider.

Or

Click on Close link to perform the action later.

Or

Click on disable button to disable access control for EPCS for logged in provider.

Note: If the eToken of the Approver is not connected, then the Approve action will fail .

III.  Usage - Pre-requisite for Prescribing an EPCS drug

Points to remember before prescribing an EPCS drug:

1. Enabling provider should enable EPCS for the Prescribing Provider.
2. Approving Provider must have DEA number.
3. Approving Provider must complete the Two-Factor authentication registration into the PrognoCIS system, so, that, while actually approving EPCS for a Prescribing provider his/her eToken is verified.
4. The approving and enabling function for a Prescribing provider cannot be done by the same individual login i.e. they need to be done by two different Users .
5. Approving can be done only after enabling is done.
6. The Prescribing Provider must procure and register the eToken
7. The Prescribing Provider must be the attending doctor of the encounter in which he wants to prescribe the CS drugs.
8. Each Provider can register/un-register only his/her eToken. One doctor cannot register/un-register another Provider‘s eToken.

Prescription for CS drugs

•  Prescribing a CS drug has specific differences in the way it is ePrescribed - there is a step involved where the Prescriber needs to sign the Prescription Refer to the following figure 3.10 and the Prescribing provider has to keep his eToken connected to the USB drive of the his/her PC.

Figure 3.10: Prescription screen displaying CS drugs type as Not Signed

•  When Prescriber saves a prescription that has controlled substances, a Summary screen popup is displayed that shows all the CS drugs that are not yet signed. Provider needs to review and mark the individual drugs as ‘ready to sign’, and then click on sign. Refer to the following figure 3.11

Figure 3.11: It is recommended Provider reads the drug detail before selecting ‘Ready to Sign' and then scroll down to click on ‘Send' button

Note: Following are the types that are displayed,

1.  Not Signed : A Controlled Substance prescription which is not digitally signed by provider.

2.  Signed : A Controlled substance Prescription which is digitally signed by Provider.

3.   eRx : A non-controlled substance prescription which can be sent electronically.

4.   Blank: The drug is not allowed to send electronically. It could be because the Provider is not registered for eRx, Pharmacy does not support eRx, or the drug is a controlled substance and the provider is not ready for EPCS.

•  The text at the end of the eRx Summary popup summarizes Provider's responsibility in legally signing the prescription and the authentication (two-factor) protocol to be followed. Refer to the following figure 3.12

Figure 3.12: Read the important information mentioned on the eRx popup and enter your login password before going ahead to click on ‘Sign' button.

•  On click of Sign button the certificate selection popup is displayed, select the certificate and click on OK. Refer to the following figure 3.13

Figure 3.13: With the selection of the certificate the two-factor authentication is complete.

•  A prescription once signed refreshes to display the Send button. The eRx Summary screen now displays the Signed CS drugs alongside the Non-CS eRx drugs. On click of send button, all signed Controlled substances plus any non-controlled substance prescriptions are sent to Surescripts.

Note: If the Prescription is sent successfully then following message is displayed “eRx sent successfully - Accepted and Verified by Surescript” and also the following message is displayed to indicate, it would be verified later by Surescripts, “eRx sent successfully - Accepted and Pending by Surescript”.

Updates of Refill Request screen

•  The look-and-feel of the Refill Request screen has changed with additional details of Medication Dispensed displayed. Refer to the following figure 3.14

Figure 3.14: New Layout of Refill Request screen

•  Refill Request for CS drug has to fulfill the two factor authentication of Password and appropriate selection of certificate; there's a single Sign n Send button that saves an additional click in the UI (User Interface). Refer to the following figure 3.15

Figure 3.15: Two-factor authentication required to refill a CS drug

•  A case wherein Refill Request for a CS drug has to be done and if the provider is not having EPCS rights then a click on Approve follows the Non-EPCS workflow, i.e. DNTF, ( Denied NewRx to Follow - This type of response indicates that the request that has been made is being denied, but that an entirely NewRx has to be sent instead. ). Refer to the following figure 3.16 . The system (PrognoCIS) navigates to the NewRx screen with the drug added.

Figure 3.16: DNTF message displayed

Note: The Pharmacy field is non-editable thus ensuring that once DNTF response is sent, the NewRx would go to the same pharmacy.

•  On click on NewRx button, the drug is not added directly but a blank, NewRx screen opens instead.

•  On print of such a NewRx, the Rx Reference No. can be printed on Prescription with the New Tag added, RX_SS__REFNO .

•  On print of an EPCS sent drug, a prefix is added to drug name tag RX_DRUG__NAME as “ [Not for Dispense, only for information] ” to ensure that, electronically sent drug does not get prescribed again on print.

•  Earlier responded Refill Request screen now appears as follows; it does not contain the Patient Received box in UI. Refer to the following figure 3.17

Figure 3.17: The UI of Refill Request details that were responded earlier is also changed

•  Old and pending (un-responded) Refill Request screens now appear as displayed in figure 3.18. No action can be allowed from this old refill request as the version is changed from 8.1 to 10.6 also at the Surescripts portal. Refer to the following figure 3.18

Figure 3.18: No changes are allowed on the refill requests that have been lying pending and are old due to version upgrade at Surescript end

On Prescription screen

•  Each time a custom drug is selected for e-prescription the system confirms if the drug to be prescribed by the Provider is NOT a DEA Class drug. Refer to the following figure 3.19

Figure 3.19: Custom or Compound drug confirmation popup

Note: Only if the user confirms by selecting the checkbox, will it allow electronic prescription of the drug.

  •  For a compound drug DEA class can be SET instantly from the formulation popup. A new field, DEA Class has been added on the formulation popup. Refer to the following figure 3.20

  Figure 3.20: Newly added DEA Class field facilitates setting of DEA Class instantly (i.e. on the fly) for a compound drug  

    Note: Setting of DEA Class for a compound drug does will be applicable only for that particular drug record at that particular instance only. It also implies that this DEA Class does not affect the Master drug record.

•  DEA Class II drugs can be prescribed for only one dispensing from the Prescription screen. By default the Refill field displays zero value and if any attempt is made to add any additional value then the system displays an alert with the message, “Refills cannot be specified for DEA class 2 drugs”. Refer to the following figure 3.21

Figure 3.21: Alert on Prescription screen not allowing more than one dispense of DEA Class 2 drugs

On Refill Request screen

•  For DEA Class II drugs the User is allowed to dispense only once. The value of Total No. of dispensing approved field on Refill Request has to be ‘1'. Refer to the following figure 3.22

Figure 3.22: The ‘Total No. of dispensing approved' or the refill value cannot be more than one

EPCS Audit Reports

•  EPCS audit reports are used to track down EPCS activity for Providers. Refer to the following figure 3.23

Figure 3.23: EPCS Audit Report details displayed

•  A new object, EPCS has been added in Reports → Audit Trail → Object drop-down menu. Report is generated based on the Provider chosen from the next field on the Audit Trail popup; if the field is blank then report is generated for ALL Providers.

•  The audited EPCS events are as follows: Refer to the Table 3.2

Table 3.2: Audited EPCS events

Note: Avoid using User Type field while generating report in order to generate a proper report.

A Patient alert when defined can now have a date range that is Effective From date and Upto Date details. Refer to the following figure 4.1-1

Figure 4.1-1 : Patient alert now has a date range defined

• A single click, ‘Check All’ option is now available on the Assign Clinical Staff popup (GoTo PrognoCIS Home screen → Clinical Staff/MA link). By selecting the option all the available Clinical Staff or MA personnel present in the list are selected thus saving the User from multiple clicks. Refer to the following figure 4.2-1

Figure 4.2-1 : With a single click all the options available are selected

• "More number of Clinical Staff or MA can now be assigned to a Provider. The database field has been enhanced to accommodate more numbers; with 25 being the earlier restriction. "

• The Deny Access popup invoked via Deny Access icon: on Patient‘s Registration screen (GoTo Patient → Register ). Now has provision to check all the available options by selecting a single option of ‘Check All'. Refer to the following figure 5.1-1

Figure 5.1-1 : Screen displaying Deny Access

"More number of PrognoCIS Users can now be denied access to a Patient's record. The database field has been enhanced to accommodate more numbers; with 25 being the earlier restriction. "

The Legal icon: that was available only on Patient’s Registration screen is now available on multiple screens such as,

•  PrognoCIS Home screen, Refer to the following figure 5.2-1 and

•  Appointment Schedule screen ( Tab: Appointment → Schedule → select a patient's appointment ). Refer to the following figure 5.2-2

Figure 5.2-1 : Legal icon – as seen on the Home screen

Figure 5.2-2 : Magnified view of Legal icon found on Appointment Schedule screen

Following are the list of enhancements done on the Patient Insurance screen:

• Patient Insurance Screen:

1. On Patient Insurance, Ins sequence field is now replaced with Default: Pri, Sec and Ter drop-down lists.

2. New field ‘Defied as' is introduced in place of ‘Status' which will display status like ‘Primary', ‘Secondary', ‘Tertiary',  ‘DMERC', ‘MotorAcc', ‘PersonalAcc', and ‘WorkerComp'.

3. Field ‘Status' will be displayed next to field ‘Defined As' and will display ‘Active' and ‘Non Active' options in drop-down list.

4. When any new Insurance is added in Insurance Table, it will check the field ‘Defined As'. If it is set to defined as ‘Primary' or ‘Secondary' or ‘Tertiary', it will appropriately set the field ‘Default Ins:' appropriately with this Insurance on top making it as either Default Primary, Secondary or Tertiary.

5. The newly added Insurance entry will be added at the end of the Table on click of button ‘Update' but on ‘Save', will be moved on the very top of the list i.e. Insurances will be displayed in reverse chronological order of entry in Insurance table.

6. Any Insurance marked with Status ‘Non Active' will automatically move at the end of the list in table. If there were other Insurances marked as Non Active already, this newly marked NonActive Insurance will be on top of that list of all Non Active Insurances.

7. The Insurance Table will not show the column ‘Sr.No' as Serial Numbers will not be needed in defining Sequence as the logic has changed to read ‘Defaults'.

8. The Insurance Table column Name ‘Status' will now show Statuses like ‘Active' or ‘Non Active'.

9. The Insurance Table now has a new column named ‘Defined As' before column ‘Status' and will display values either ‘Primary', ‘Secondary', ‘Tertiary',  ‘DMERC', ‘MotorAcc', ‘PersonalAcc', ‘WorkerComp' appropriately.

10. Drop-down list ‘Default Ins: Pri, Sec and Ter' will only show Insurances defined as Primary Secondary and Tertiary. Insurances Defied As – WC, AA, OA and DMERC will NOT be shown in drop-down lists to set Defaults. Hence Insurances defined as WC, AA, OA and DMERC cannot be set as Defaults on Patient Insurance Screen.

11. If Patient has only Insurance with Defined as ‘WC, AA, OA or DMERC' then Default drop-down list will be blank.

12. User can set Default Insurances as per his preferences by overriding the auto set defaults or existing defaults.

13. Insurances with Status as Non Active will not be shown in Drop-down lists ‘Default Ins: Pri, Sec and Ter'.

14.Drop-down lists ‘Default Ins: Pri, Sec and Ter' will display qualifying Active Primary, Secondary and Tertiary Insurances in reverse chronological order of entry in table.

15. Drop-down lists ‘Default Ins: Pri, Sec and Ter' will not have any check for Validity From and Expiry Date. So even if Insurance has expired, it will be shown and selected in Drop downs ‘Default Pri, Sec and Ter'.

16. If Insurance assigned as 'Default Ins : Pri, Sec or Ter' is deleted then on save it should assign next eligible Insurance with same ‘Defined as' in its place automatically. For e.g. If 2 Insurances are there with ‘Defined as' Secondary, latest added Secondary insurance is set with Default Sec. As soon as deleting the default Sec Ins and save it should set Default Sec with another available Sec Insurance instead of showing select.

17. On changing ‘Defined as' between Primary, Secondary and Tertiary for an existing Insurance, if respective ‘Default' is 'Select', then on Patient Insurance screen's update or save, this Insurance Name should be set as either 'Default Ins: Pri, Sec or Ter' appropriately matching the ‘Defined As'. For E.g. If Patient Ins has 3 Insurances with ‘Defied as' 'Primary' then on changing the ‘Defied as' from Primary to Secondary respective Insurance name should be populated in ‘Default Sec'.

18. If ‘Default Ins: Pri' is not selected then user cannot select ‘Default Ins: Sec and Ter' on click of save, showing msg “Cannot set Default Sec when Default Pri not selected.” Same checks are applicable when ‘Default Ins: Ter' is assigned without assigning ‘Default Ins: Pri and Sec'.

19. User cannot associate same Insurance Name as Default in more than one drop-down lists ‘Default Ins: Pri and Sec and Ter'. If associated, it shows appropriate msg like “Default Pri and Sec cannot be same.”.

20. After upgrade from V2B11 to V2B12, all existing Insurance Records will be retained in table but shown as per the current logic of Reverse Chronological order of entry. All Non Active Insurances will be shown at the end of active Insurances list in table in Reverse Chronological order in which they were marked Non Active.

21. After upgrade from V2B11 to V2B12, existing data will display drop downs ‘Default Ins: Pri, Sec and Ter' as per defined in field ‘Sequence' which was governing defaults till version ‘V2B11'.
For e.g. if for a patient, Sequence field showed Serial No. ‘1, 2, 3' or ‘3, 2, 1' or ‘2, 3, 1' then drop-down lists ‘Default Ins: Pri, Sec and Ter' 1 st entry will display Insurance as per Sequence number. It will ignore the Status ‘WC', ‘AA', ‘OA' and ‘DMERC' Insurances while assigning them as Defaults automatically.

• Patient Insurance Import changes

a. Advanced MD Interface
Advanced MD Interface logic is governed by Insurance sequence whereas now PrognoCIS has removed the logic of Insurance sequence. As a result, the handling of Patient Insurance import from Advanced MD to PrognoCIS has been changed.

Coverage set as in Advanced MD will be set as ‘Defined As' in PrognoCIS. Coverage options in Advanced MD match the Defined As field options in PrognoCIS: ‘Primary, Secondary, Tertiary, Workers Comp, Motor Acc, Personal Acc, DMERC.

Earlier, Insurance Sequence was read from Advanced MD and accordingly PrognoCIS Sequence field was populated. Same way, Status field was populated as per Status in Advanced MD.

Now, Sequence is still read and since there are ‘Default: Primary, Secondary and Tertiary' fields introduced, Sequence 1 Insurance is set as Default Primary, Sequence 2 Insurance as Default Secondary and Sequence 3 Insurance as Default Tertiary, provided they are of any coverage Primary, Secondary and Tertiary. Insurances with Coverage Workers Comp, Motor Acc, Personal Acc and DMERC in Advanced MD are added to Patient Insurance table with appropriate ‘Defined As' but not set as Defaults even if present in first 3 sequences in Advanced MD because PrognoCIS Defaults logic does not allow setting Workers Comp, Motor Acc, Personal Acc and DMERC as defaults. The Enc Type driven logic will pick them up as Primary on marking the Appointment as Arrived.

Since PrognoCIS has Status separated from Defined As, Status ‘Active' and ‘Non-Active' in PrognoCIS now match with Status in Advanced MD and Active Insurances when marked Non-Active in Advanced MD are appropriately imported as Non-Active Status in PrognoCIS and Vice Versa.

Note:  Mappings will have to be changed for Coverage ó Defined As and mappings will have to be added for Status ó Status (Active, Non-Active).

• Changes related to Subscriber Relation as Employer

    When Employer is selected as Subscriber ‘Relation' from dropdown,

•  All the fields of ‘Subscriber's section on Patient Insurance pop-up will be shown disabled, just like when Relation is selected as ‘Self'.

•  On click of button ‘Update' and ‘Save' of Patient Insurance screen, validation will be performed if Employer is present on ‘Contacts' tab of Patient Registration screen.

*If not, an error will be presented on Contacts tab: “Employer Name Not Selected on Patient Registration”.

* If ‘Defined As' is ‘Workers Comp', and Relation is NOT Employer it will show an error “Subscriber Relation must be Employer for upcoming Worker Comp CMS 1500 02/12”. This new validation has been added considering that new CMS1500 02/12 will have this requirement and EDI claims for Workers Comp already has this requirement.

*If Employer was found, the name will be set in the field ‘Employer Name'.

•  If Employer is changed later on Contacts tab: 

*If changes from A to B:  The corresponding change will be made on all his Patient Insurance records where relation was ‘Employer'.

*If changes from A to Blank: All his Patient Insurance records where relation was ‘Employer' will be changed to relation ‘Self'

*If changes from Blank to A: No impact on Patient Insurance records.

You get to view Patient's history details from the time the patient's record is newly added. Refer to the following figure 5.4-1

Figure 5.4-1: A newly added patient record displaying the details of Patient's Registration history

Insurance history is active or available right from the time a new Insurance record is added. Refer to the following figure 5.5-1

Figure 5.5-1: A newly added insurance record displaying on the Patient's Insurance history

In case of an existing Patient, ‘Personal Details' and ‘Address Details' options are now by default set to unchecked in Card Scan popup (GoTo Patient → Register → Card scan Icon). Whereas if the Patient is new, ‘Personal Details', ‘Address Details', and ‘Image'options are now by default set to checked in Card Scan popup (GoTo PrognoCIS Patient → Register → Card Scan Icon). And a User has to explicitly change this information – if required. Refer to the following figure 5.6-1

Figure 5.6-1 : The options are all checked by default for new Patient on Card Scan popup

‘Patient Band’ is available on patient’s Encounter screen. Refer to the following figure 6.1-1

Figure 6.1-1 : The patient’s name available on Patient band is configurable with a new property

Clinic now has the provision to display patient’s name according to their requirement as the display of Patient name is now configurable. Depending upon the value set in the (new) property, patientband.tag.r1.c1 the patient’s name is displayed.

Note: Currently the property has [PT_NAME_SHORT__NAME] SET as its default value.

i. NOT TRACKED records of Vaccination can be hidden from view in PrognoCIS Depending on the value set (Y/N) in the newly added property, facesheet.vaccination.hide.nottracked a Clinic can decide to either hide the trace of NOT TRACKED vaccination record details from the Face sheet cell as well as from the Records Tab on the Vaccination screen OR display them as before.

ii. Correct sequence followed while sending information such as CVX code and CPT code in the RXA segment of the Vaccination Export process. A new HL7 property, vaccination.export.by ensures that a correct sequence of CVX and CPT codes of vaccination is followed at the time of vaccination export. The process now sends the Vaccines’ CVX code to the State registry, if the CVX code is found absent then the vaccines’ associated CPT code is sent.

Note: In the absence of both CVX and associated CPT codes, system does not export any information.

iii. Multiple Lot numbers can be added to a single manufacturer It is now possible to add multiple Lot numbers for the selected manufacture in vaccination screen while administering vaccine.

Navigation GoTo: Patient Encounter → TOC → Vaccination → Click Vaccine (+) button → Click Administer button → Administer popup

And

Navigation GoTo tab: Settings → Configuration → Vaccines ; Refer to the following figure 6.2-1

Figure 6.2-1 : Administer Vaccine popup displaying multiple Lot numbers added for the single manufacture

• On click of the Add New icon ,the popup is invoked to add the lot number for the selected manufacture; Refer to the following figure 6.2-2

Figure 6.2-2 : Popup displaying adding new lot number for the single manufacture

• On click of the Edit Lot No icon , the popup is invoked to edit the existing lot number for the selected manufacture ; Refer to the following figure 6.2-3

Figure 6.2-3 : Popup displaying modifying lot number for the single manufacture

iv. The property (new), facesheet.vacrecord.hide.nottracked when set as 'Y' hides all the NOT TRACKED vaccines from the Face sheet Cell.

Note: If the manufacturing date has not been entered in earlier version of PrognoCIS then on upgrade (to the current version of V2B12) these record(s) would not be carried forward.

v. On version upgrade only the Lot No. of last encounter is carried forward and stored in a newly added table. For example: If for the vaccine DTAP lot number is L12 in Jan 2013, L13 in Feb 2013 and L14 in Mar 2013 are been added for the encounters, then on upgrade in Aug 2013 only L14 which is the lot no. of last encounter is added in table at the backend and will be displayed in drop-down along with the newly added lot numbers

Note: In earlier version Lot No was free text field which is now a drop-down field, and the data is fetched from the newly added table in the database.

It is now possible to delete component tests individually from the Radiology Result screen. A checkbox option provided with each test when selected and saved deletes the component test(s) from the Radiology result. Refer to the following figure 6.3-1

Figure 6.3-1 : Screen displaying Delete checkbox to delete component

The EGA displayed is now more clearly defined and the format for displaying has been changed with the No. of weeks being specified with a 'W' after the number and the No. of days being specified with a 'D' after the number. For example if the Estimated Gestational Age of a Patient's fetus is 21 Weeks and 4 days old then on PrognoCIS it is displayed as (21W + 4D), Refer to the following figure 6.4-1 and 6.4-2

Figure 6.4-1 : Estimated Gestational Age of a Patient's fetus with W and D format on Speciality screen

Figure 6.4-2 : Screen displaying Estimated Gestational Age of a Patient's fetus with W and D format on doctor Form screen

•  Support has been provided to assign multiple ICDs to a Radiology test on Radiology Order screen (GoTo patient Encounter → TOC → Radiology Order). The feature is property dependent i.e. if the property, rad.order.tests.assign.multipleICD is set as 'Y' then it is possible to assign multiple ICDs to individual Radiology tests from Radiology Order screen. Refer to following figure 6.5-1

Figure 6.5-1 : Multiple ICDs assigned to each radiology test

•  Following two tags (new) have been added to print multiple assigned Radiology ICDs on Progress Notes:

•  RAH_ASSIGNED__ICDS

•  RAH_ASSIGNED__ICDS$

Navigation GoTo: Patient → Encounter → TOC → Start Encounter screen

• Without Scheduling an Appointment, if directly Start Encounter from EMR, Patient ?Encounter screen, by default its bringing default Primary Insurance in Primary drop down and default Sec Insurance in Secondary drop down.

• Before saving Start Encounter, if Encounter Type or Case is selected or changed, Pri and Sec Insurances get changed respectively.

• After Scheduling an Appointment with Case or Pre-Auth and instead of mark it as Arrive if user directly starts the Encounter from EMR, Patient → Encounter screen, by default its bringing default Primary Insurance in Primary drop down and default Sec Insurance in Secondary drop down irrespective of selected Case or Pre-Auth insurance as Primary Insurance.

Navigation GoTo: Patient → Encounter → TOC → Edit Encounter screen

• On Edit Encounter screen, two new drop-down fields, Primary Insurance and Secondary Insurance are added to be able to change the Primary and Secondary Insurance if required. On Claim, these Primary and Secondary Insurances from Edit Encounter will be read. The selection of DEFAULT Insurances pulled on this screen is governed by details on Appointment in following priority order: Case Insurance, Pre-Auth Insurance, Encounter Type Insurance and if none of these is present, then from Patient Insurance screen’s ‘Default:Pri and Sec set.

• The Primary Insurance drop-down list shows all the Active Non-DMERC Insurances from Patient Insurance screen only, including Defined As ‘Primary, Secondary, Tertiary, WorkerComp, AutoAcc, PersonalAcc’ and in brackets shows the abbreviation for each like ‘Pri’, ‘Sec’, ‘Ter’, ‘WC’, ‘AA’, ‘OA’ for easy identification. These Insurances are listed in descending order in drop down list to match the Table on Patient Insurance screen i.e latest added Ins on Patient Insurance screen is on top in this drop down.

• The Secondary Insurance drop-down list shows only those Insurances which are Defined As ’Primary, Secondary and Tertiary. Insurances ‘Defined As’ WorkerComp, AutoAcc, PersonalAcc and DMERC’ are not shown in Secondary Insurance Drop Down.

• On Start / Edit Encounter screen, Effective From and Upto Date is displayed next to the fields Primary Insurance and Secondary Insurance if selected Insurance has Date Range defined on Patient Insurance Screen; here, there are no checks for Expired Insurance. Looking at the Effective From and Upto Date, the users can decide whether to continue to keep the expired Insurance or Insurance not yet in effect as Defaults.

• On Start/Edit Encounter, if Case No is changed, the Primary Insurance automatically changes to Insurance associated to select Case on Case Management screen.

• On Start/Edit Encounter, if Encounter Type is changed, the Primary Insurance automatically changes to Insurance as per the Claim Type associated to Encounter Type.

• On Start/Edit Encounter, if user changes the Primary or Secondary Insurance, there are no validations applicable even if there is a mis-match of Insurance with Case, Pre-auth or Encounter Type or Defaults on Patient Insurance screen. Appropriate validations are applicable on Claim Screen.

• Insurance association is now at encounter level thus there are newly added tags to print encounter insurance; wherever patient's insurance tags were used are now replaced with encounter insurance tags.
    'PT_INS' tags with 'ENC_INS'

• Following are the tags newly added to print Insurance details associated to an Encounter:

Table 6.8-1: Table displaying a list of newly aded tags

• These tags, will be identical with all Patient Insurance tags with functionality as below:

1.  Since Encounter Insurances are explicit now, Enc Tags for Insurance (ENC_INS)have been introduced to print the Primary and Secondary Insurances associated to Encounter of a patient and not Default Primary and Secondary Insurances on Patient Insurance screen.

2.  Since only Primary and Secondary Insurances can be associated to Encounter and not Tertiary, only 2 sets of tags are provided, for Primary (Starting with [ENC_INS_) and for Secondary(starting with [ENC_INS2_).

3.  The earlier tags which printed Encounter Insurances (i.e. PT_INS tags), their logic has been changed to print the Default Primary, Secondary and Tertiary Insurances of Patient set in ‘Default' dropdown fields on Patient Insurance screen.

4. All the output templates in PrognoCIS given below will be changed during Upgrade to replace all ‘PT_INS' tags with ‘ENC_INS' tags wherever applicable.
a. Progress Notes, b. Forms, c. Patient Signature, d. Preprinted, e.Letters, f. Lab Order, g.Lab Result, h. Radiology Order, i. Radiology Result, j. Prescription k. Encounter Report, l. Appt Report, m.Billing, n. e-mail, o. Label
Note :

1. After upgrade, if any clinic needs to print the Default Insurances on Patient Insurance screen, they will have to get the ‘[ENC_INS_' tags replaced by ‘[PT_INS_' tags.

2. Any template which has ‘PT_INS3…' tags present to print Tertiary Insurance, after upgrade, these tags will remain as is since there is no Tertiary Insurance available on Encounter. Users might have to remove them if they don't want Patient's Tertiary Insurance from Patient Insurance Default to be printed on those templates if present.

5.  The Patient Band will print the Encounter's Primary Insurance now in place of Patient Insurance if Patient Band was set to print Primary insurance. During upgrade, the properties ‘patientband.tag.r1.c1' to ‘patientband.tag.r4.c4' will be checked and if the tag ‘[PT_INS_COMPANY]' is found, it will be replaced by tag ‘[ENC_INS_COMPANY]'.

6.  The Primary Insurance printed on CPOE Rx and Refill pop-ups will print Encounter's Primary Insurance instead of Patient Insurance.

7.  The tooltips on Appointment Schedule and Home Page will now print the Encounter Insurance instead of Patient Insurance. For this following properties will be read and tag [PT_INS_COMPANY]' if found, it will be replaced by tag ‘[ENC_INS_COMPANY]': appointment.tooltip.patient home.appt.tooltip.patient

8.  On Encounter Tests defined with ‘Result Type' = ‘Tag', if tags like [PT_INS….] are used, and users Encounter tags like [ENC_INS….] to be used there, they will have to manually go and change the Test definition.

Note: Functionality of ENC_CCF tags, tags like MST_LAB_INS_CARR_CODE (on Lab Order) and BLH_INS (on Billing side)  remains the same.

Navigation GoTo: Patient → Encounter → TOC → Assessment link → Assessment screen; A common delete checkbox has been newly added that helps in deleting all the ICDs and CPT/HCPC available with a single click. Refer to the following figure 6.9-1

Figure 6.9-1: A common delete as seen on ICD tab, similar checkbox is also available on CPT/HCPC tab

_LETTER_TOFAX_ and _LETTER_TOEMAIL_ are two tags that are newly introduced to print the addressee's FAX number and Email ID on a Letter Out template from Patient → Letter-Out screen.

Messages that have been replied to or have been forwarded by a PrognoCIS User are now easily identifiable due to the indication given by the following icons:

Table 8.1-1: Table displaying relevant contact list that can be displayed in the To drop-down list if details are present

Nos.	Icons	Indicates
1.		The icon with a pink arrow going towards its left indicates that a ‘Reply’ to the   message has been sent by the User.
2.		The icon with a blue arrow going towards its right indicates that the message has   been forwarded by the User.

Provision is made to increase and decrease the font size of generated Tabular report.

It is now possible to increase and decrease the font size of generated Tabular report. The two new icons are added in Tabular report screen as follows:

        Icon :To Increase the font size of report

        Icon: To Decrease the font size of report

Navigation GoTo: Report → Tabular , Refer to the following figure 9.1-1

Figure 9.1-1: Newly added icons In Tabular Report screen

A new property, report.show.generatedby has been added for Tabular report generated. The property when set as ‘Y' displays the creation date and timestamp information of the tabular report along with the name of the person who generated the same. Refer to the following figure 9.2-1

Figure 9.2-1: Report Generated by information displayed along with report creation date and timestamp information

There is a newly added provision to define follow-up days to an Encounter type from the Encounter Master.

Navigation GoTo tab: Settings → Configuration → Clinics column → Enc Type link → Encounter Type screen → Follow up drop-down menu list. Refer to the following figure 10.1-1

Figure 10.1-1: Newly added drop-down menu list to the Encounter Type screen

A selected follow-up day becomes the number of days for follow-up for the defined Encounter type. Refer to the following figure 10.1 -2

Figure 10.1-2: Follow-up drop-down menu list displayed in detail

Navigation GoTo tab: Settings → Configuration → Clinics column → Enc Type link → Encounter Type screen → Default Complaints field. Refer to the following figure 10.2-1

Figure 10.2-1: Three complaints assigned as default to an Encounter type

The default complaints that are defined in the Encounter Type screen is or are available on the HPI screen on start/edit of an Encounter. Refer to the following figures 10.2-2 and 10.2-3 

Figure 10.2-2: A patient's encounter started with the Encounter type consisting of pre-defined ‘Default Complaints'

Figure 10.2-3: The ‘Default Complaints' displayed by default on the HPI screen on start of the patient's encounter

Conditions:

• If an Encounter's type is changed then the default complaint list displaying on HPI will also change accordingly.
• If an Encounter's type is changed after any updates to the original and default complaint list then the HPI screen would not only display complaints of the latest Encounter type but also the updated list of the first Encounter type.

Example: A patient's encounter is started with the Encounter type as ET1. The Complaints list displayed for the specific ET1 type of encounter is CT1 and CT2. Now, the provider updates CT2 with patient's details and saves the details. In the course of the current encounter, the Provider goes ahead and changes the Encounter type from ET1 to ET5 whose associated complaints are CT3 and CT4. In the HPI screen now after the change of Encounter type, the list of complaints that would be displayed is CT3, CT4, and also CT2.

• A new operator, ‘Between’ has been added in Expression master screen to help a User to add range values.

Between: The “Between” operator is used to select values within a range.

Navigation GoTo tab: Settings → Configuration → Workflow column → Expression → Operator drop-down menu list. Refer to the following figure 10.3-1

Figure 10.3-1: Newly added value in Operator drop-down menu list

•  A new operator, ‘Between' has been added in Expression master screen to help a User to add range values.

• A new History button has been added to the Properties screen (tab: Settings → Configuration → column: Admin → link: Properties). Refer to the following figure 10.4-1

Figure 10.4-1: Properties screen displaying newly added history button

•  A new popup, Properties History displays the following information about the Property: the Property tag, its current value, last User who modified the value, the time the modification was done, and the comments if any that was entered by the User at the time of change. Refer to the following figure 10.4-2

Figure 10.4-2: The history popup displaying the history of record modification done to Properties

Navigation GoTo tab: Settings → Configuration → column: Admin → link: Role; The right to approve an order sheet is now based on the access rights given to a role. Refer to the following figure 10.5-1

Figure 10.5-1: Access Right for a Nurse role being defined in the image

• A new result type, ‘Custom’ added to test template helps User to add a third-party application to be invoked via PrognoCIS; the data captured from the 3 rd party application is printed on Progress Notes via a string tag, [ENC_SPL_STR__LINE] .

• The property, test.resulttypes now intakes an additional value of ‘O’ representing ‘Custom’ .

Appointment Schedule popup now has a provision to select current encounter’s patient name with a single click.

A newly added icon: on Appointment Schedule popup helps User to fetch current encounter’s patient without going through the process of manually searching for the patient. When user clicks on the icon, the name of the current encounter patients is displayed in the Name field.

Navigation GoTo tab: Appointment → Schedule → Appointment Schedule popup; Refer to the following figure 11.1-1

Figure 11.1-1: Newly added Current encounter Patient icon on Appointment Schedule popup

• The About PrognoCIS screen on the Home page now displays additional information about PrognoCIS.

• Information is displayed in organized manner with aptly labeled title such as Clinic Information; Other Modules; Lab Interface; Radiology Interface and Code. Refer to the following figure 11.2-1

Figure 11.2-1: About PrognoCIS popup displaying Clinic and Other Module information, to read remaining information User has to scroll down.

1. The disclaimer information remains unchanged.

2. Clinic Information – displays the same information as in the earlier versions with information such as Clinic Name; Clinic Id; Version; Build; Service Pack; Patch No.; #Providers.

3. Other Module –displays additional information and also the information that were earlier not available. The list is as follows, Billing Support; RCM; eRx; Patient Portal; IPL; Sync; Text Reminder; Ref Doc Portal; Vaccination Export. The values typically displayed are ON or OFF.

4. Lab Interface: displays the Bi directional vendor(s) as comma separated value, similarly for the Lab Results. Refer to the following figure 11.2-2

Figure 11.2-2: About PrognoCIS popup displaying Lab, Radiology, and Code information

5. Radoloigy Interface: displays the Bi directional vendor(s) as comma separated value, similarly for the Radiology Results.

6. Code – displays the information, if new update is available and the date on which last update was done for FDB; ICD codes; CPT/HCPC codes. This section also displays if a new DRG code is available.

7. The Contact and Support information remain unchanged.

• The new UI of Appointment Schedule popup has fields such as Name, Duration, and Enc Type – with Insurance and current Patient icon being the newly added elements. Refer to the following figure 11.3-1

Figure 11.3-1: Comparing the changes and rearrangement between two versions

•  If Case is selected, its associated Insurance Name is displayed.

•  If Pre-Auth No is selected, the Name of selected Pre-Auth Insurance is displayed.

•  In absence of Case No or Pre-Auth, field ‘Insurance' is blank even if special Encounter Type or Default Insurances are set on Patient Insurance.

•  On selection of Patient, if Pre-Auth is available, the hyperlink will be enabled.

•  On selection of Case, if Pre-auth is available for that Case Insurance, the hyperlink ‘Pre-Auth' will be enabled.

•  If Case or Pre-auth is un-selected, Insurance Name is no more displayed.
The selections on Appointment Scheduler while marking the Appointment as ‘Arrived' decide the Default Primary Insurance and Secondary Insurance on Edit Encounter screen.

•  The pop-up ‘Patient Workflow' on Appointment Schedule has been changed as follows:

a.  There are two new fields added on Patient Workflow pop-up for selecting or changing Primary and/or Secondary Insurance. The names of the fields are ‘Primary Insurance' and ‘Secondary Insurance'.

b.  These two new fields are displayed only after the Appointment Status has been marked ‘Arrived' i.e. after Encounter Starts. This will help the Front Desk person to change the Primary and Secondary Insurances associated to Encounter being on the Appointment → Schedule screen.

c.  Since on Encounter Close i.e. when the Status changes to ‘Complete', the icon ‘Patient Workflow' becomes disabled OR a s soon as Status changes from Arrived to something else(It should be enabled till Encounter is closed), these two new fields ‘Primary Insurance' and ‘Secondary Insurance' cannot be viewed or changed from the Appointment → Schedule screen.

•  Start/Edit Encounter screen now has two new fields ‘Primary Insurance' and ‘Secondary Insurance'. The default ‘Primary Insurance' and ‘Secondary Insurance' as on Edit Encounter screen are displayed on this ‘Patient Workflow' pop-up.

•  Any addition or changes done to default ‘Primary Insurance' and ‘Secondary Insurance' from this ‘Patient Workflow' pop-up will be reflected on Edit Encounter screen.